The relevance of comorbidities for heart failure treatment in primary care: A European survey.

Aim: To assess the impact of comorbidities on chronic heart failure (CHF) therapy.

Methods: The IMPROVEMENT-HF survey included 11,062 patients from 100 primary care practices in 14 European countries. The influence of patient characteristics on drug regimes was assessed with multinomial logistical regression.

Results: Combined drug regimes were given to 48% of CHF patients, consisting of 2.2 drugs on average. Patient characteristics accounted for 35%, 42% and 10% of the variance in one-, two- and three-drug regimes, respectively. Myocardial infarction (MI), atrial fibrillation (AF), diabetes, hypertension, and lung disease influenced prescribing most. AF made all combinations containing beta-blockers more likely. Thus for single drug regimes, MI increased the likelihood for non-recommended beta-blocker monotherapy (OR 1.3; 95% CI 1.2-1.4), while for combination therapy recommended regimes were most likely. For both hypertension and diabetes, ACE-inhibitors were the most likely single drug, while the most likely second drugs were beta-blockers in hypertension and digoxin in diabetes.

Conclusions: Patient characteristics have a clear impact on prescribing in European primary care. Up to 56% of drug regimes were rational taking patient characteristics into account. Situations of insufficient prescribing, such as patients post MI, need to be addressed specifically.